Study On Measurement Of Financing Demand And Influencing Factors Of Expenditure For Urban MFA

Medical Finance Assistance (MFA) is a series of financial, policies and technical assistances to help the poor and disadvantaged groups to access necessary medical services when they are suffering intolerable economic burden of disease, which is supplied by the government or some social organizations. It is an integral part of basic health security system and is considered to be the most direct and effective way to contain health poverty, promote health equity and improve health service quality for the poor people. Establishing and improving MFA system is not only an important public function of modern government, but also and demonstration to protect the basic health rights for people.Since the government launched urban MFA in some pilot cities in 2005, Urban MFA System has developed rapidly in the past 5 years. It has become the bottom of our multi-level health security system. However, compared with developed mature and stable social security system, the Urban MFA system is at a rapid developing and improving stage. There are many technological bottlenecks, such as the conflict between huge health demand and limited MFA funds, high precipitation and low utilization of funds. It is necessary and helpful for us to accurately measure the financing demand and forecast the expenditure of MFA fund, which should be researched and resolved urgently.Objective:This study is aim to building up a calculation model on the basis of reasonably define the scope of urban MFA, develop a relatively accurate, easy operated methods to measure the financing demand of urban MFA and explore the influencing factors of utilization of MFA.Method:This study combined with the theoretical and empirical research methods and lots of health economic method and social research methods, such as literature research, logical inference, cost-benefit analysis and some other statistics methods, were used to build up the financing demand model and the practical measurement of financing demand of urban MFA in sample area. Meanwhile, Chi-square test and logistical regression analysis were used to explore the influencing factors of the utilization of MFA.Result:â… .Theoretical analysis on the function of urban MFAWith analysis on the macro-system environment of urban health security system and the location of MFA, we found that the relationship between urban MFA and BMI had changed from a parallel relation into a vertical articulation. The role to complement health security system's coverage weakened, but the role of the bottom of our multi-level health security system becomes more and more prominent and obvious. Research pointed out the urban MFA should cover urban poor residents; including residents lived by the Minimum Living Standard Security System and low-income patients with serious illnesses, which are out of the protection of BMI or suffering huge economic burden of disease after the compensation of BMI. Meanwhile, the government should actively develop the social charity to help the residents, who suffered serious disease and huge medical cost, and jointly build a solid medical security system of the bottom.â…¡. Define the scope of urban MFA reasonablyOn basis of the analysis of the critical line of the families'economic risks for health care of the poor, we found that poor residents lived by the urban subsistence allowances couldn't resist any economic risk of diseases, while the low-income residents had the capability to effectively protect the basic health service utilization and maintain their basic living, but hospital care is still difficult to bear. With the limited MFA funds, it is necessary to make a different treat for residents with urban subsistence allowances and low-income residents for assistances. Urban MFA should offer a comprehensive protection to poor residents lived by the urban subsistence allowances, while take low-income families' inpatient services into coverage of MFA.â…¢. Compare and Cost-benefit analysis of different MFA modelsAt present, the urban MFA could divide into simple model and comprehensive model according to the relationship between the MFA and BMI. The former is relatively independent, while the latter is integrated with BMI. Cost-benefit analysis on the two models showed that transition of the urban MFA models from simple model to comprehensive model couldn't necessarily bring increase of medical security for the poor residents. There are many key factors is closely related to cost-benefit ratio of the comprehensive MFA mode, such as premium rate, protected content, the actual compensation rate of BMI and the utilization of medical services. Empirical research on data of the national average and Yubei District of Chongqing city both showed that it was not cost-effective to funding the poor residents to participate urban BMI, which resulted in the reverse transfers of MFA funds between the poor residents and the others.â…£. Construction of the measurement model for the financing demand of urban MFAAccording to the systematic analysis of reciprocal relationship among need, demand and supply, the financing demand of Urban MFA is defined as the fund that the government is willing and able to be raised to assist the poor residents in the current conditions, who can't afford disease burden with the compensation of BMI, social assistance system and family support. On the basis of the definition and the demand of health care, we built up a model to measure the financing demand of urban MFA, which could be divided into five key steps as following:(1) Measurement of MFA targets'economic risks of disease; (2) Excluding the compensation of BMI by hierarchical analysis of costs and measure the private economic risks of the disease for MFA targets themselves; (3) According to the critical line of the families'economic risks for health care, measure the financing demand of urban MFA in idea condition;(4) Taking deduction criterion, cap line and compensation ratio into consideration as in practice, making hierarchical analysis and accumulation of outpatient and hospital cost that afforded by MFA targets themselves and measure the actual financing demand of urban MFA; (5) According to growth of medical costs and expandation of urban MFA, achieve dynamic measurement of Financing Demand of Urban MFA.â…¤. Deduction of method of measurement for the financing demand of urban MFA and empirical studyIn accordance with the five key steps of the measurement model for financing demand of urban MFA, we deduced the general formula for each step and establish a viable method on the base of measurement of economic risk. According to the actual data about the utilaizaiton of both medical services and MFA in Yubei distriction of Chongqing City in 2009, we made a empirical study on the measurement of financing demand of MFA in 2010, after the adjustment of Yubei cooperative medical insurance policy. Without consideration of the growth of health cost in 2010, the financing demand of MFA in YuBei distrition will be about 11.3381 million yuan (including MFA targets'insured funds 4.401 million yuan funded by government) and 220.82 yuan per capita.If we take the growth of health costs in 2010, the financing demand will be 11.5315 million yuan (224.58 yuan per capita), about 1.14 times of the actual expenditures of MFA in 2009.â…¥. Analysis on Influencing Factors of the utilization of MFAAt present, the application and utilization of MFA, especially the inpatient services of MFA, is based on the utilization of medical services. So the utilization of MFA could be broken down into two relatively independent but interrelated processes:the use of medical services and apply for MFA, according to the process of medical care utilization. Based on the data of household survey, we analyses the influencing factors of the utilization of MFA with chi-square test and unconditional Logistical regression analysis. The univariate analysis showed that health status of residents, medical insurance forms, monthly per capita income, monthly per capita expenditure on health care, knowledge of MFA policies and the implementation period of MFA were associated with the utilization of MFA. According to the results of univariate analysis, we built up probability model of the utilization of MFA inpatient services for urban poor residents. Unconditional Logistical regression analysis of the influencing factors for the utilization of MFA inpatient services also showed many factors such as health status of residents, monthly per capita expenditure on health care, knowledge of MFA policies, restrictions on the variety of diseases and MFA deduction criterion significantly impact the utilization of MFA inpatient services.